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Meijering D, Welsink CL, Boerboom AL, Bulstra SK, Vegter RJK, Stevens M, Eygendaal D, van den Bekerom MPJ. Triceps Insufficiency After Total Elbow Arthroplasty: A Systematic Review. JBJS Rev 2021; 9:01874474-202107000-00008. [PMID: 34270508 DOI: 10.2106/jbjs.rvw.20.00281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The incidence of triceps insufficiency after total elbow arthroplasty (TEA) varies in the literature, and a consensus on treatment strategy is lacking. We review the incidence, the risk factors, the clinical presentation, and the diagnosis and treatment of triceps insufficiency after TEA. Based on this information, we have formulated recommendations for clinical practice. METHODS We performed a systematic review of the literature from January 2003 to April 2020 to identify studies that investigated triceps function following TEA by searching the PubMed, Cochrane, and Embase databases. Eligible studies (1) reported on triceps function following primary or revision TEA for every indication, regardless of technique (e.g., bone grafts), (2) included ≥6 adult patients, (3) had the full-text article available, and (4) had a minimum follow-up of 1 year. RESULTS Eighty studies with a total of 4,825 TEAs were included. The quality was low in 15 studies, moderate in 64 studies, and high in 1 study. The mean incidence of triceps insufficiency was 4.5%. The rates were highest in patients after revision TEA (22%), in those with posttraumatic arthritis as an indication for surgery (10.2%), and after a triceps-reflecting approach (4.9%). Most studies used the Medical Research Council scale to score triceps function, although cutoff points and the definition of triceps insufficiency differed among studies. Surgical treatment showed favorable results with anconeus tendon transfer and Achilles allograft repair when compared with direct repair. CONCLUSIONS The incidence of triceps insufficiency varies greatly, probably due to a lack of consensus on the definition of the term. Therefore, we recommend the guidelines for clinical practice that are presented in this article. These guidelines assist clinicians in providing the best possible treatment strategy for their patients and help researchers optimize their future study designs in order to compare outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniëlle Meijering
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Chantal L Welsink
- Department of Orthopedic Surgery, Isala Klinieken, Zwolle, the Netherlands
| | - Alexander L Boerboom
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Riemer J K Vegter
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands.,Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Chou TFA, Ma HH, Wang JH, Tsai SW, Chen CF, Wu PK, Chen WM. Total elbow arthroplasty in patients with rheumatoid arthritis. Bone Joint J 2020; 102-B:967-980. [PMID: 32731835 DOI: 10.1302/0301-620x.102b8.bjj-2019-1465.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aims of this study were to validate the outcome of total elbow arthroplasty (TEA) in patients with rheumatoid arthritis (RA), and to identify factors that affect the outcome. METHODS We searched PubMed, MEDLINE, Cochrane Reviews, and Embase from between January 2003 and March 2019. The primary aim was to determine the implant failure rate, the mode of failure, and risk factors predisposing to failure. A secondary aim was to identify the overall complication rate, associated risk factors, and clinical performance. A meta-regression analysis was completed to identify the association between each parameter with the outcome. RESULTS A total of 38 studies including 2,118 TEAs were included in the study. The mean follow-up was 80.9 months (8.2 to 156). The implant failure and complication rates were 16.1% (95% confidence interval (CI) 0.128 to 0.200) and 24.5% (95% CI 0.203 to 0.293), respectively. Aseptic loosening was the most common mode of failure (9.5%; 95% CI 0.071 to 0.124). The mean postoperative ranges of motion (ROMs) were: flexion 131.5° (124.2° to 138.8°), extension 29.3° (26.8° to 31.9°), pronation 74.0° (67.8° to 80.2°), and supination 72.5° (69.5° to 75.5°), and the mean postoperative Mayo Elbow Performance Score (MEPS) was 89.3 (95% CI 86.9 to 91.6). The meta-regression analysis identified that younger patients and implants with an unlinked design correlated with higher failure rates. Younger patients were associated with increased complications, while female patients and an unlinked prosthesis were associated with aseptic loosening. CONCLUSION TEA continues to provide satisfactory results for patients with RA. However, it is associated with a substantially higher implant failure and complication rates compared with hip and knee arthroplasties. The patient's age, sex, and whether cemented fixation and unlinked prosthesis were used can influence the outcome. Level of Evidence: Therapeutic Level IV. Cite this article: Bone Joint J 2020;102-B(8):967-980.
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Affiliation(s)
- Te-Feng A Chou
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsuan-Hsiao Ma
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jou-Hua Wang
- Department of Orthopaedics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Fong Chen
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
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Welsink CL, Lambers KT, van Deurzen DF, Eygendaal D, van den Bekerom MP. Total Elbow Arthroplasty. JBJS Rev 2017; 5:e4. [DOI: 10.2106/jbjs.rvw.16.00089] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Prkic A, Welsink C, The B, van den Bekerom MPJ, Eygendaal D. Why does total elbow arthroplasty fail today? A systematic review of recent literature. Arch Orthop Trauma Surg 2017; 137:761-769. [PMID: 28391430 DOI: 10.1007/s00402-017-2687-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Total elbow arthroplasty is a relatively uncommon type of arthroplasty, which has undergone several design changes in the past four decades. However, research on improvement requires knowledge of failure mechanisms that can be addressed. Therefore, we conducted a systematic review on modes of failure of total elbow arthroplasty. METHODS We conducted searches on PubMed/Medline, Embase and Cochrane databases to identify studies describing modes of failure of primary total elbow arthroplasties. The results were coupled per type of total elbow arthroplasty and individual arthroplasty models. RESULTS A total of 70 articles were included in this systematic review. 9308 individual total elbow arthroplasties were identified with 1253 revisions (13.5%). Aseptic loosening was the most prevalent reason for revision (38%), followed by deep infection (19%) and periprosthetic fractures (12%). CONCLUSION Revision rates have been found similar to a systematic review published in 2003. The revision percentage of total elbow arthroplasty for rheumatoid arthritis is significantly higher than for trauma and post-traumatic osteoarthritis. Aseptic loosening was seen less in linked implants. Infections and periprosthetic fractures did not differ between linkage design groups. Aseptic loosening remains the most frequent cause for revision of primary total elbow arthroplasty. Therefore, more research on the occurrence, progression and risk factors of aseptic loosening should be performed and lead to higher implant survival.
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Affiliation(s)
- Ante Prkic
- Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands.
| | - Chantal Welsink
- Department of Orthopaedic and Trauma Surgery, OLVG, Amsterdam, The Netherlands
| | - Bertram The
- Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - Denise Eygendaal
- Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
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Riedel K, Beaton DE. Update on the state of outcome measurement in total elbow arthroplasty research: identifying a need for consensus. J Bone Joint Surg Am 2013; 95:e97 1-8. [PMID: 23864188 DOI: 10.2106/jbjs.k.01420] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is little consensus for a standard set of metrics to express outcome after total elbow arthroplasty. In order to set the stage for future work toward a core set of measurement tools, our goal was to gather a complete view of the outcomes used in total elbow arthroplasty research, the concepts of their focus, and their quality as measures of the target concept. METHODS We reviewed the outcome measures for total elbow arthroplasty presented in the literature from 2004 to 2011 in terms of the instruments used and their concepts of focus. We reviewed the reliability, validity, and responsiveness of the prevailing measurement tools. RESULTS Of the seventy-two articles identified, 90% (sixty-five) used elbow-specific aggregate outcome measures, which combine concepts, such as physiological variables, with symptom status and functional status. The Mayo Elbow Performance Score, or a variation of that scoring system, was used in fifty-four (75%) of the seventy-two articles. Most outcomes pertained to biological and physiological variables, with fewer outcomes focusing on symptoms, function, or overall health status. A review of the measurement properties of the elbow-specific aggregate outcome measures did not reveal one to be superior. CONCLUSIONS Overall, total elbow arthroplasty outcomes are heterogeneous in their reporting and lack standardization. The total elbow arthroplasty literature relies on several physician-derived elbow-specific aggregate measures and focuses primarily on physiological variables. The relative merits of aggregating findings into a single scoring system versus as separate components should be explored further. Finally, consideration should be given to patient-reported outcome measures in total elbow arthroplasty research. CLINICAL RELEVANCE This study of the current "state of practice" for outcome measurement in total elbow arthroplasty revealed gaps in the breadth of measurement and a lack of comparability in elbow scoring systems that could hinder our ability to clearly and fully understand outcome after total elbow arthroplasty. Future consensus work could address both concerns and assist in the development of a core set of outcome measures.
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Affiliation(s)
- Kelly Riedel
- Mobility Clinical Research Unit, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada.
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Abstract
Total elbow arthroplasty (TEA) is still in its infancy if we compare it with other arthroplasties such as knee or hip. TEA designs have been evolving with experience; however, long-term outcome data remain limited. The designs of total elbow prostheses can be subdivided into 3 general categories: unlinked, linked, and convertible devices. This article focuses on unlinked and convertible prostheses.
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Abstract
The elbow is often involved in the progression of rheumatoid arthritis. Because of the elbow's unique role in maneuvering and positioning the hand in space, loss of normal elbow motion, loss of stability, or increased pain with the use of the elbow are all significant sources of impairment in patients with rheumatoid arthritis. The improvements in disease-modifying medications have greatly diminished the prevalence of severe elbow degeneration among patients with rheumatoid arthritis. However, it hasn't been eliminated. In this article the authors discuss strategies for managing it.
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Voloshin I, Schippert DW, Kakar S, Kaye EK, Morrey BF. Complications of total elbow replacement: a systematic review. J Shoulder Elbow Surg 2011; 20:158-68. [PMID: 21134667 DOI: 10.1016/j.jse.2010.08.026] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 08/17/2010] [Accepted: 08/24/2010] [Indexed: 02/01/2023]
Affiliation(s)
- Ilya Voloshin
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA.
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Kleinlugtenbelt IV, Bakx PAGM, Huij J. Instrumented Bone Preserving elbow prosthesis in rheumatoid arthritis: 2-8 year follow-up. J Shoulder Elbow Surg 2010; 19:923-8. [PMID: 20713278 DOI: 10.1016/j.jse.2010.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 05/01/2010] [Accepted: 05/08/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to analyze the clinical and radiological results of elbow arthroplasty using the instrumented Bone Preserving (iBP) elbow prosthesis, which is the 6(th) iteration of the Kudo prosthesis, in patients with rheumatoid arthritis. METHODS From December 1999 to August 2006, 20 total elbow replacements in 19 patients with rheumatoid arthritis were performed by 2 surgeons using the iBP. The humeral component is uncemented and the ulnar component cemented. There were 14 women and 5 men. The period of follow-up was 2-8 years, with a mean of 49 months. The mean age at time of operation was 62 years (range, 32-80). The Larsen grade and The Mayo Elbow Performance Score were used. Possible radiolucent lines or displacement of the components were evaluated yearly. RESULTS The preoperative radiographs showed that all of the involved elbows were in grade 3-5 with an average of 4.1. All patients had a poor elbow before operation. Two elbows were moderately unstable. Three complications occurred: 1 intraoperative fracture of the medial condyl, 1 postoperative dislocation, and 1 persistent sensory ulnar neuropathy. After surgery, at the last follow-up, 3 patients had fair results, 5 good, and 12 excellent. In 6 cases, radiographic loosening of the ulnar component was observed without any clinical symptoms; none around the humeral component. CONCLUSION The iBP elbow prosthesis in patients with rheumatoid arthritis shows good to excellent clinical results, despite radiolucency around the cemented ulnar component in some cases.
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Bernardino S. Total elbow arthroplasty: history, current concepts, and future. Clin Rheumatol 2010; 29:1217-21. [PMID: 20683741 DOI: 10.1007/s10067-010-1539-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 07/19/2010] [Indexed: 11/29/2022]
Abstract
Total elbow arthroplasty (TEA) has proven to be a reliable joint replacement procedure that has a high degree of patient satisfaction. The long-term functional and implant survival scores rival those of total knee arthroplasty. Despite these favorable outcomes, few patients with disabling elbow degenerative conditions have TEA recommended to them as an alternative procedure by rheumatologists, physiatrists, or orthopedists. This article reviews the history, current concepts, and future of TEA.
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Affiliation(s)
- Saccomanni Bernardino
- Orthopaedic and trauma Surgery, University of Chieti (Italy), via dei Vestini, 66013, Chieti Scalo, Italy.
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